VARIOUS: The European Union is not doing enough to fight a dangerous outbreak of tuberculosis among its neighbours which poses a major threat to the continent, health agencies say

The European Union needs to do more to more to fight a dangerous outbreak of tuberculosis among its neighbours which poses a major threat to the continent, health agencies are saying. About 450,000 people become infected with tuberculosis each year in the Europe region, including Eastern Europe and Central Asia, says the World Health Organisation (WHO). Nearly 70,000 of these contract strains of the easily-spread respiratory ailment that resist the two main tuberculosis drugs, raising the likelihood that the disease could lead to epidemics in the Western Europe on the scale of that seen in the 1940s. Mario Ravigilione, director of the Who's Stop TB division, says the emergence of drug resistant strains in Europe is worrying. "In Europe what we see today is the emergence and the spread of strains of tuberculosis that we call extensively drug resistant, which means also resistant to second line drugs, not only the first line drugs that we use normally, in parts of Eastern Europe, particularly the Baltic countries, as well as in Russia and other Central Asia republics, and that is a concerning issue," Raviglione told Reuters. Widespread poverty and a gradual breakdown of the health system have led to a dramatic increase of TB in Russia. Spreading in the same way as a common cold, Russia's TB epidemic is now among the worst in the world. According to Russia's Health Ministry, some 120,000 people were suffering from TB in 2005, almost twice as much as 15 years ago, and, in terms of population size, eight times more than in western-Europe. The situation is most worrying in Russia's vast impoverished Siberian region where the TB death rate is much higher than in the rest of the country. Hospitals in Siberia's remote areas regularly run out of antibiotics needed to treat TB. Premature interruption of treatment often leads to the development of a dangerous strain of TB that is resistant to most drugs except a cocktail of expensive medicines beyond the reach of most. On top of that, many hospitals lack equipment to detect at an early stage the disease, which often starts by attacking the lungs. "The problem is late diagnosis, caused by old methods we use. We use a bacterial method which takes three to four months before we can diagnose the disease. Of course we need new equipment to detect the drug resistant tuberculoses," said Yevgeny Victorovic Nekracov, a doctor at the Tomsk regional Tuberculosis hospital. In 2000, international organisations kicked into action. With the backing of the World Health Organisation, they picked Tomsk, an industrial city in the heart of Siberia, to launch what they say was the world's first project against multi drug resistant TB. They financed medical equipment, trained medical staff and brought in an array of medicines needed to cure multi drug resistant TB. But, fighting tuberculosis requires a lot of investment and proper financing says Raviglione. "The fight against tuberculosis requires a lot of investment and requires financing, proper financing, we can never be happy because TB is still in this continent, it's still in Europe, and it's actually in some parts of Europe, like Eastern Europe and the former Soviet Union, it's rampant. So what is necessary there is a strong commitment by the local governments to do what is necessary and a strong commitment from the Western European countries to help in this fight" said Raviglione. In Ukraine, TB prevalence in Ukraine grew annually by 15% to 20% until 2000 as a result of the more and more difficult economic and social situation, says WHO. But this year, for the first time, the trend has been reversed which WHO says is thanks to an internationally recommended TB treatment strategy called DOTS. In Kiev, the City TB Hospital Number One is the only TB hospital in the Levoberexnaya region. The region on the left bank of the river Neper has a population of about one million people. And, at the state-funded Number One hospital there are only 268 beds available. The evolution of the drug-resistant strains has meant treatment has become more difficult and patients need to stay in hospital longer, creating a bed shortage " We have no free places left. We are almost at the point that we have to put additional beds in the rooms. We have a queue for hospitalisation of patients. We simply do not have enough places," said Larisa Kobalienko, head of the first department of the Kiev City TB Hospital Number One. The WHO has estimated that donors need to nearly triple spending levels to $56 billion over 10 years to halt the global spread of tuberculosis. EU expansion alone will multiply the region's tuberculosis exposures says the International Red Cross and Red Crescent Federation (IFRC). Migration from Eastern Europe and Central Asia will also raise risks of drug-resistant strains spreading in cities such as London, where tuberculosis infection rates have been steadily climbing over the last decade.. " "What's dangerous about this epidemic is the drug resistance factor, it's not so much the quantity of cases, it's the quality of them. MDR is extremely tenacious, it's very difficult to treat, it's very expensive to treat. It only takes a small outbreak and we've seen those outbreaks already in Europe, in Italy, in the Netherlands, in the UK and in some other countries. So it's simply something that the European Union has to focus much more on that it has until now," explained IFRC coordinator for Europe and Central Asia, Michael Luhan. Russia's notorious prisons, often located in cramped buildings with facilities dating back from the Gulag times, have long been a breeding ground for TB. Alongside the civil programme, health organisations in Tomsk also run a program in the city's number one prison. Prisoners here are regularly screened for TB and moved to a special TB facility when ill. Thanks to the program the mortality rate in the prison has dropped to zero, compared to 15 out of 100,000 in Tomsk and 35 out of 100,000 in Siberia. But Tomsk Number One Prison is an exception. And more funding is needed to reach the rest of Russia's 850,000 prisoners. "TB is something for Western Europeans in the past. All families in Europe have some history in their family from the earlier 20th century because the epidemic was the biggest killer of European at that time, but it isn't in the past, it's very present and it's very near." The explosion in multi-drug resistant tuberculosis, rooted in patients not taking the full course of their drugs, has meant that Europe is nowhere ready to meet global targets on controlling the disease, said Luhan. Some countries, including Latvia, have also been found to have cases of extreme drug-resistant tuberculosis which does not respond to at least three of the six existing classes of second-line tuberculosis drugs, says WHO. The European Centre for Disease Prevention and control, Medecins du Monde and more than 20 other health agencies and non-governmental groups said European governments needed to intensify their tuberculosis fight.

ITN Source | October 15, 2006

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